D E C L A R A T I O N

I ______________________________________________ son/daughter/wife of

_______________________________________ Born on ____________________________

at ____________________________ holder of Indian Passport No.____________________________

Issued  to  me  by   the  Regional  Passport  Office/Embassy/High  Commission/Consulate  General  of India 

___________________________ do hereby solemnly affirm and declare that:

1.  I still hold Indian nationality.

2.  I have neither applied for nor obtained Canadian citizenship.

3.  In the event of my acquiring Canadian nationality on a subsequent date I shall surrender the Indian Passport to the nearest Indian Diplomatic Mission and in the event of my failing to do so, I shall be liable for action under the provisions of the Indian Passport Act, 1967.

Date:

Place : Vancouver, B.C. Canada                                               (Signature of the Applicant)

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Last Updated: 11/18/2008